The U.S. drug crisis does not appear to be letting up. The nation experienced a shattering 47,000 opioid-related overdose deaths in 2017.Driving the surge are potent, cheap synthetics like fentanyl that have spread into the illicit drug supply. In response, communities have been trying a range of interventions, from increasing the availability of the antidote naloxone to upping treatment resources.But an analysis released Thursday by the Rand Corporation, a policy think tank, concludes it's time to pilot an approach from outside the U.S.: offering pharmaceutical-grade heroin — yes, heroin — as a form of treatment for longtime heroin users who haven't had success with other treatments. It's already happening in several European countries and Canada. But prescribing heroin would challenge culture, laws and practice in the U.S."These are controversial interventions," says lead author Beau Kilmer, who co-directs RAND's drug policy research center. "There are some people that don't even want to have conversations about this. But given where we are with opioid deaths near 50,000 and fentanyl deaths near 30,000, it's important that we have discussions about these interventions that are grounded in the research and grounded in the experiences of other countries."​Here's how programs that offer prescription heroin, or heroin-assisted treatment, work. Patients typically get a regular, measured dose of pharmaceutical-grade heroin — also known as diacetylmorphine or diamorphine — and inject it under close medical supervision inside a designated clinic. The idea is if people have a legal source of heroin, they'll be less likely to overdose on tainted street drugs, spend less time and energy trying to get their next fix, and instead be able to focus on the underlying drivers of their addiction."This is just another treatment that could help stabilize lives,"says Kilmer.It's not meant for everyone. Medications like methadone, buprenorphine and naltrexone are highly effective treatments that function in different ways to address cravings and withdrawal symptoms or block the effects of drugs. But these first-line treatments don't work for some longtime opioid users. In Canada's main study of prescription heroin, eligible patients had already tried quitting heroin an average of 11 times.Prescription heroin as a form of maintenance therapy dates back to the early 1920s in the UK, and revved up in the 1990s in other parts of Europe. (It was even allowed in the U.S. before the sweeping federal drug laws of the early 20th century.)Heroin-assisted treatment is different from the concept of supervised consumption sites, where patients bring their own illicit drugs and then inject them while medical staff are present, ready to respond in case of an overdose. These are increasingly debated in the U.S. as at least a dozen cities consider them.Kilmer says prescription heroin has been researched with more rigorous methods. Several randomized controlled trials in Canada, the United Kingdom and the Netherlands found that people addicted to heroin benefited from the approach, according to RAND's analysis. They were more likely to stay in treatment compared with those who took methadone, and they were less likely to revert to using illicit heroin. Evidence also suggests that prescription heroin may be more effective than methadone in reducing criminal activity and improving patients' physical and mental health.For Dr. Chinazo Cunningham, an addiction specialist at Albert Einstein College of Medicine and Montefiore Medical Center in the Bronx, alternative approaches are important, but she thinks it's more imperative in the U.S. to focus on what she sees as the most pressing issue right now: "We have treatment that works, we just need to provide it in a way that is accessible to people," she says.As it stands, a vast majority of people who could benefit from first line treatments for opioid use disorder aren't getting it, a problem that's even driving a black market for treatment."It's hard for me to imagine heroin-assisted treatment because I think right now even talking about getting more mainstream treatment like methadone, buprenorphine and naltrexone to people, there's already so much stigma around it," says Cunningham.As part of the analysis, RAND conducted focus groups and interviews in several New Hampshire and Ohio counties hit hard by the overdose crisis. The idea of prescription heroin was new to many and was met with skepticism over its acceptability from health professionals, local leaders, and those in treatment. People worried that heroin-assisted treatment "would enable drug use" and face community resistance.​Elana Gordon is a health reporter and a 2018-2019 Knight Science Journalism Fellow at MIT. You can follow her on Twitter: @elana_gordon.

TO CONTINUE READING:https://www.npr.org/sections/health-shots/2018/12/06/673986164/is-america-read

CDC Estimates Nearly 2.4 Million Americans Living with Hepatitis CNew data highlight urgent need to diagnose and cure more Americans, and to address rising infections due to U.S. opioid crisisNearly 2.4 million Americans – 1 percent of the adult population – were living with hepatitis C from 2013 through 2016, according to new CDC estimates published today in the journal Hepatology.Medications that cure hepatitis C offer the hope of eliminating the disease in the U.S., yet, today’s report suggests that millions are infected and have not benefited from these new treatment options. Expanded testing, treatment, and prevention services are urgently needed, especially in light of the surge in new infections linked to the opioid crisis.“Every American who has been cured of hepatitis C is living proof that ending this epidemic is possible,” said CDC Director Robert R. Redfield, M.D. “Hundreds of thousands of Americans have already been cured. In order to achieve our goal, we must commit to ensuring that everyone living with hepatitis C is tested and treated.”To estimate total hepatitis C prevalence in the United States, researchers analyzed blood test results from the nationally representative National Health and Nutrition Examination Survey (NHANES) from 2013 through 2016. They also analyzed data from other studies of groups not surveyed in the NHANES, including active duty members of the military, and people who are incarcerated or homeless.Opioid crisis puts new generations at risk of hepatitis C infectionsAdding to the burden of those already living with hepatitis C, separate CDC surveillance data indicate that the number of new infections each year in the United States is disturbingly high and on the rise. Acute hepatitis C cases reported to CDC more than tripled from 2010 to 2016, with most new hepatitis C infections due to increased injection drug use associated with the nation’s opioid crisis. Based on these data, CDC estimates that more than 41,000 Americans were newly infected with hepatitis C in 2016 alone.“Seeing an undiagnosable infection become a curable disease has been a public health highlight of the past 30 years. But the shadow of the opioid crisis puts our nation’s progress at risk,” said Jonathan Mermin, M.D., director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “Tackling hepatitis C requires diagnosing and curing people living with the virus and cutting off new infections at the source.”Hepatitis C affects nearly every generationHepatitis C now poses a serious health threat to three generations of Americans, all of whom need to be reached with prevention services, testing, and treatment: Baby boomers (born between 1945 and 1965) account for a large portion of all chronic hepatitis C infections in the United States and currently have the highest rate of hepatitis C-related deaths. CDC recommends that all adults born between 1945 and 1965 get a one-time test for hepatitis C, but only a small fraction have done so. Adults under 40 have the highest rate of new infections, largely because of the opioid crisis. Infants born to mothers with hepatitis C are a growing concern. The overall risk of an HCV-infected mother transmitting infection to her infant is approximately 4 percent to 7 percent per pregnancy. From 2011 through 2014, national laboratory data indicate that the rate of infants born to women living with hepatitis C increased by 68 percent.Eliminating hepatitis C requires substantial national commitmentEven though new treatments can cure hepatitis C virus infections in as little as two to three months, far too many Americans have not been effectively treated. They may be unaware of their infection or they are unable to access medication because they lack healthcare coverage or have financial restrictions.In addition to expanding testing and removing barriers to treatment, authors of the new report stress that intensified programs to prevent, track, and respond to new hepatitis C infections are also essential to reducing the number of infections. Prevention efforts to address new infections include support for comprehensive community-based prevention services. Such services focus on drug treatment and recovery and reducing transmission of viral hepatitis and HIV through hepatitis A and B vaccination, testing, linkage to care and treatment, and access to sterile syringes and injection equipment.“Until we as a nation remove the barriers to hepatitis C testing and treatment, it will continue to cost us dearly – both in terms of dollars and American lives,” said Dr. Mermin. “Every death from hepatitis C is a reminder of a promise not yet realized for far too many.”For more information visit: www.cdc.gov/nchhstp/newsroom.###CDC works 24/7 protecting America’s health, safety and security. Whether diseases start at home or abroad, are curable or preventable, chronic or acute, or from human activity or deliberate attack, CDC responds to America’s most pressing health threats. CDC is headquartered in Atlanta and has experts located throughout the United States and the world.U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Marvin Jackson, 70, has been an avid tennis player for most of his life. When he noticed that his urine was a deep brown color, he wrote it off as a symptom of dehydration.Then, in 2012, Jackson, who is African American, learned from his doctor that his dark urine was actually a sign that he had hepatitis C. Hepatitis C is a serious infection that affects the liver but can have few symptoms.Unhappy with his doctor’s bedside manner, he delayed returning for a follow-up after his diagnosis. When he did return, he got another stunning diagnosis from a different doctor.“He says, ‘Marvin, you’ve got liver cancer,’” Jackson recalled. Untreated hepatitis C is one of the causes of the illness. “Before I get a chance to let it all sink in, he’s telling me what we’re gonna do.”Jackson had a liver transplant in 2013. Recovery has been a challenge, he said, but now he’s reached a “new normal.”African American and Latinos Face Increased Rates of Liver Cancer, Higher Death RiskJackson’s case is not uncommon. People of color have long had higher rates of liver cancer, and data recently released by the Centers for Disease Control (CDC) suggests that the disparity persists.The study, released in July, showed that death rates for liver cancer in adults (aged 25 and up) increased by 43 percent between 2000 and 2016.Researchers also found sharp disparities in death rates by race. The rate for non-Latino whites was 9 per 100,000. Asian and Pacific Islanders (APIs) and African Americans both had death rates of 13.6 per 100,000. Latinos had the highest death rates of 14.6 per 100,000.While they remain high, death rates among APIs have dropped significantly since 2000, when the rate was 17.5.In California, liver cancer incidence and death rates have also declined among APIs since 2000. Yet rates among Latinos and African-Americans have increased over that same period, according to data from the California Cancer Registry.Just over half of liver cancer cases arise from well-established risk factors, like viral hepatitis, cirrhosis, and non-alcoholic fatty liver disease, according to Salma Shariff-Marco, a UCSF professor who works on the Greater Bay Area Cancer Registry. Researchers, health care professionals and advocates are doing their best to screen, prevent and treat for those risk factors.TO CONTINUE: http://www.calhealthreport.org/2018/10/25/people-color-face-higher-rates-hep-c-deadly-cases-liver-ca

Governor Andrew M. Cuomo today announced the members selected to join the Task Force that will advise the state on its Hepatitis C Elimination Plan. The creation of the Task Force is the next step toward finalizing the Elimination Plan and builds on recommendations presented by community stakeholders at the New York State Hepatitis C Elimination Summit in 2017."The members selected for this task force are some of the finest in their fields, and their invaluable experience will provide us with the information we need to develop an attainable elimination plan," Governor Cuomo said. "This strategic plan will not only improve the quality of life for those living with Hepatitis C, but also ensure that New Yorkers have the support and resources they need to prevent this disease.""Our comprehensive approach to eliminating Hepatitis C will help to save lives and bring peace-of-mind to millions of New Yorkers," said Lieutenant Governor Kathy Hochul. "Like so many other issues, New York is leading the nation, and developing a new approach to combating this deadly disease. The Task Force will bring together the best and the brightest to focus on creative solutions, helping to improve the health of New Yorkers and ensure Hepatitis C becomes a concern of the past."The work of the Task Force will be supplemented by five workgroups: Prevention; Testing and Linkage to Care; Care and Treatment; Surveillance, Data and Metrics; and Social Determinants. Task Force and workgroup members include representatives from community based organizations, people living with and affected by hepatitis C, health care providers, payers, public health experts, researchers, harm reduction specialists and social service providers.In March, Governor Cuomo announced New York State's commitment to eliminate hepatitis C by increasing access to testing, treatment and education in order to connect New Yorkers in high-risk communities with available services. In July, the Governor outlined his strategy for hepatitis C elimination, which included the allocation of $5 million for hepatitis C services, such as education; patient navigation; care and treatment programs in harm reduction settings; removal of insurance barriers; expansion of hepatitis C treatment capacity; Medicaid reimbursement for harm reduction services; and the expansion of syringe exchange access.More than 100,000 New Yorkers are living with Hepatitis C—a liver disease caused by the hepatitis C virus—and most are unaware that they have it. Three out of four people living with hepatitis C are baby boomers. Hepatitis C is spread by blood to blood contact, with the most common risk factor for hepatitis C being injection drug use. Over the past decade, there has been a shift in the distribution of hepatitis C cases, with a distinct peak emerging among younger people aged 20 to 40, which has been fueled in part by the growing opioid epidemic. Left untreated, hepatitis C causes cirrhosis and liver failure, resulting in liver transplant, liver cancer or death. New available treatments can cure almost all patients in just 12 weeks. The expansion of harm reduction services, outlined in the Governor's plan, will help stop hepatitis C transmission among people who inject drugs.

TO CONTINUE AND SEE TASK FORCE MEMBERS: https://www.governor.ny.gov/news/governor-cuomo-announces-selection-hepatitis-c-elimination-task-force-members

​Experts have designed and validated models to predict the risk of hepatocellular carcinoma (HCC) in patients infected with hepatitis C virus (HCV) following antiviral treatment, according to new research published in the Journal of Hepatology.

Researchers have developed an online calculator that estimates an HCV-infected patient’s risk for hepatocellular carcinoma after antiviral treatment.From these models, the researchers designed an online calculator, now available at www.hccrisk.com, that estimates a patient’s HCC risk after treatment.“It is important that we can model the risk of hepatocellular carcinoma in these patients, so that we develop the optimum screening strategy that avoids unnecessary screening, while adequately screening those at increased risk,” wrote authors led by George N. Ioannou, MD, MS, Division of Gastroenterology, Department of Medicine, Veterans Affairs Puget Sound Healthcare System, University of Washington, Seattle, WA.Most Americans with chronic HCV are now treated with direct-acting antivirals (DAAs) for 3 to 5 years. This treatment eradicates HCV in the majority of these patients, with sustained virologic response (SVR) rates exceeding 90%. After achieving SVR, the risk of HCC is significantly reduced.“It follows that HCC risk needs to be estimated specifically for the period following antiviral treatment, incorporating whether SVR was achieved or not, and that previous models predicting HCC risk in untreated HCV-infected patients do not apply to patients who have undergone antiviral treatment,” the authors wrote.Although current guidelines call for screening HCV-infected patients with cirrhosis, there is no such mandate for non-cirrhotic HCV-infected individuals, despite the HCC risk. This “one-size-fits-all” strategy is problematic in the age of DAA treatment and, according to the authors, requires improvement.

Yale Medicine experts share opinions on common misconceptions that may be preventing people from getting help.Between 2015 and 2016, drug overdose deaths went from 33,095 to 59,000, the largest annual jump ever recorded in the United States. That number is expected to continue unabated for the next several years. We talked to a panel of Yale Medicine experts who weighed in on the three most harmful and widely held misconceptions that are preventing large groups of people from getting treatment

Myth #1: Opioid addiction is just a psychological disorder and people who are dependent simply need better willpower. Richard Schottenfeld, MD, Psychiatry

​It’s important to define opioid addiction carefully, because the stigma is so strong. Someone who is prescribed opioid medications for pain for prolonged periods may develop tolerance, which means they need a higher dose to get pain relief. Or they may experience withdrawal symptoms when they stop taking the medication. But these are not considered cases of opioid addiction.Opioid addiction, or technically “opioid use disorder,” is defined as loss of control over use of opioids. This means that the person continues to use opioids despite negative consequences or is unable to stop using opioids despite wanting to. This person may also have a preoccupation with using opioids, obtaining opioids or craving for opioids. These patients may also develop tolerance or experience withdrawal when they stop using, but those symptoms by themselves do not define an opioid use disorder.Some people think that an opioid addiction is just psychological or a weakness of character, and that people who are addicted simply don’t have the willpower to stop. But it’s more complicated than that. Long-time use of opioids in an addictive way actually alters brain functioning. It causes chronic and lasting changes in the brain reward system, causing the person to feel less motivation and get less pleasure from other, naturally occurring rewards. Opioids become the primary reward and the primary focus of the person’s life, and they need more of it to activate the reward system.

Richard Branson, Virgin.comFor years, I’ve been on a mission to help end the so-called war on drugs, an epic failure of global and national drug policies that has led to the loss of countless lives, wasted billions in taxpayer funds and continues to needlessly criminalize millions of people - often just for the possession of small amounts of illicit drugs for personal use.

This relentless pursuit of a drug-free world has done absolutely nothing to stem the global flow of drugs, to curb supply or reduce demand in any noticeable fashion. Drugs are all around us. Our communities are not one bit safer, and our children have greater access to illicit substances than at any point in the last 50 years.One look at Mexico and Colombia will suffice to understand how the futility of the drug war has exacerbated a vicious cycle of violence that has created more casualties than drug use itself. But the problem is truly global. Year after year, we cede control of a vast, illicit drug market – equal in size to the global textile trade – to criminal organisations with no regard for public health or safety. It’s a deadly business turning over more than 300 billion dollars annually, remarkably capable of escaping intervention and fighting back. No matter what governments throw at it – from blunt force to harsh sentencing – many don’t seem to understand that the illegal drug trade in all its facets is a renewable resource, an indomitable regenerative force driven by nearly unmatched growth potential.​TO CONTINUE READING: https://www.virgin.com/richard-branson/why-i-think-its-time-regulate-drugs

BOSTON — To the medical students, the patient was a conundrum.According to his chart, he had residual pain from a leg injury sustained while working on a train track. Now he wanted an opioid stronger than the Percocet he’d been prescribed. So why did his urine test positive for two other drugs — cocaine and hydromorphone, a powerful opioid that doctors had not ordered?It was up to Clark Yin, 29, to figure out what was really going on with Chris McQ, 58 — as seven other third-year medical students and two instructors watched.“How are you going to have a conversation around the patient’s positive tox screen results?” asked Dr. Lidya H. Wlasiuk, who teaches addiction awareness and interventions here at Boston University School of Medicine.Mr. Yin threw up his hands. “I have no idea,” he admitted.Chris McQ is a fictional case study created by Dr. Wlasiuk, brought to life for this class by Ric Mauré, a keyboard player who also works as a standardized patient — trained to represent a real patient, to help medical students practice diagnostic and communication skills. The assignment today: grappling with the delicate art and science of managing a chronic pain patient who might be tipping into a substance use disorder.

How can a doctor win over a patient who fears being judged? How to determine whether the patient’s demand for opioids is a response to dependence or pain?Addressing these quandaries might seem fundamental in medical training — such patients appear in just about every field, from internal medicine to orthopedics to cardiology. The need for front-line intervention is dire: primary care providers like Dr. Wlasiuk, who practices family medicine in a Boston community clinic, routinely encounter these patients but often lack the expertise to prevent, diagnose and treat addiction.

According to the Centers for Disease Control and Prevention, addiction — whether to tobacco, alcohol or other drugs — is a disease that contributes to 632,000 deaths in the United States annually.But comprehensive addiction training is rare in American medical education. A report by the National Center on Addiction and Substance Abuse at Columbia University called out “the failure of the medical profession at every level — in medical school, residency training, continuing education and in practice” to adequately address addiction.Dr. Timothy Brennan, who directs an addiction medicine fellowship at Mt. Sinai, said that combating the crisis with this provider work force is “like trying to fight World War II with only the Coast Guard.”

Now, a decade-long push by doctors, medical students and patients to legitimize addiction medicine is resulting in blips of change around the country. A handful of students has begun to specialize in the nascent field, which concentrates on prevention and treatment of addictions and the effect of addictive substances on other medical conditions. In June, the House of Representatives authorized a bill to reimburse education costs for providers who work in areas particularly afflicted by addiction.There are only 52 addiction medicine fellowships (addiction psychiatry is a separate discipline), minuscule compared to other subspecialties. In August, the first dozen finally received gold-standard board certification status from the Accreditation Council for Graduate Medical Education (by contrast, there are at least 235 accredited programs in sports medicine).While most medical schools now offer some education about opioids, only about 15 of 180 American programs teach addiction as including alcohol, tobacco and other drugs, according to Dr. Kevin Kunz, executive vice president of the Addiction Medicine Foundation, which presses for professionalization of the subspecialty. And the content in all schools varies, he noted, ranging from one pharmacology lecture to several weeks during a third-year clinical rotation, usually in psychiatry or family medicine.Programs rarely go deeper. But Boston University braids addiction training into all four years.This 75-minute session to teach B.U. students the nuances of assessing a pain patient is already unusual. What also distinguishes it is the presence of an addiction medicine fellow, Dr. Bradley M. Buchheit of Boston Medical Center.

Dr. Lidya Wlasiuk, third from right, teaches medical students how to treat patients with addictions respectfully. “Language matters,” she said. “Avoid saying, ‘I found this out.’ Instead, say, ‘This was in your urine screen.’ You want to keep that conversation going, not shut it down.”CreditKayana Szymczak for The New York Times“What isn’t present in his tox screen?” Dr. Buchheit prompted students.Fidgety silence.“What we’ve prescribed him — Percocet,” Dr. Buchheit told them.“So we have to figure out where that Percocet has been going.”And suddenly the medical maze surrounding Mr. McQ became even more complex.

Asking about cocaine useWhen you are a twenty-something medical student, fists clenching nervously in the pockets of your white medical coat, learning to get gruff, grizzled Chris McQ to disclose uncomfortable truths is not readily gleaned from a textbook. Mr. McQ is crusty and defensive. As students resorted to the same chirpy rejoinder — “Awesome!”— he tried not to flinch. The man just wanted pain meds.In each small-group session, a student had 15 minutes to assess Mr. McQ and make a plan. Mr. McQ once had a cocaine problem. His girlfriend was taking hydromorphone, known as Dilaudid, for back pain. Was he at risk for misusing opioids?“Ask him about his pain first,” Dr. Wlasiuk told the students. “Language matters. Avoid saying, ‘I found this out.’ Instead, say, ‘This was in your urine screen.’ You want to keep that conversation going, not shut it down.”The students had learned about “motivational interviewing,” a technique that encourages patients to articulate health goals. As medicine moves away from doctor-knows-best paternalism, students are being schooled in engaging the patient with a joint-decision-making, team approach.Before Mr. McQ entered the classroom, the students debated: Was he selling Percocet to buy cocaine? Stealing his girlfriend’s Dilaudid?Dr. Buchheit cautioned: “Substance use disorder is a chronic, relapsing disease. So is diabetes. Diabetics don’t follow a diabetic diet 100 percent of the time. If they were to have a slip-up, we would figure out what went wrong and say ‘Is there anything else we can do?’”Despite the urgent need for addiction medicine education, there are considerable barriers to establishing it. Hours of training have already been meted out to conditions deemed critical. Making time in a jammed schedule can mean another subject has to be shrunk.

Because addiction medicine is young, most medical schools can’t rely for expertise on fellows — post-graduate students who steep themselves in a subspecialty. Fellows would typically consult on addiction-related cases in hospitals and clinics, educate medical students and supervise residents in primary care fields where these patients first appear: family medicine, emergency medicine, obstetrics.And so the field of addiction medicine struggles to perpetuate itself.Dr. Daniel Alford, a professor and associate dean at Boston University, is a driving force behind its curriculum. “The biggest challenge now is how do you sustain it?” he said. “Who keeps updating it? When faculty leave, who will replace them?”There is not much incentive to specialize in addiction medicine. According to a 2017 study, insurance disparities can be striking. Insurance views addiction treatment as an afterthought to mental health therapy, which itself trails reimbursement for physical health care.The reasons for resisting this career are also cultural. The stigma that attaches to patients also clings to doctors who treat them. The patients are often dismissed as manipulative and incurable; caring for them is seen as a thankless endeavor.

At a South Boston community health center, Chioma Anyikwa (left), a medical student, counsels a patient, Sharon, who is in recovery from opioids.CreditKayana Szymczak for The New York Times“I really enjoy working with these patients,” Dr. Buchheit told the students. “They have often been kicked to the curb by the formal medical system. They don’t trust us. So for them to walk into a room and have a doctor say, ‘It’s great to see you, thank you for coming in,’ is very powerful. And then you can see them get better with treatment. It can be very rewarding work.”The students tried out approaches on Mr. McQ. “You called our office and wanted an early refill on your Percocet,” said one. “But it’s important that you come in. I’m glad you’re here and we can maintain our relationship.”

Mr. McQ told one student that his pain had worsened — that he ran through his prescription, tried to get more and took some of his girlfriend’s Dilaudid.Mr. McQ suggested that the doctor switch him to Dilaudid.“Time out!” Mr. Yin, the student, said, turning to the class.“What are you struggling with?” Dr. Wlasiuk asked him.Mr. Yin replied that he didn’t want to reward the patient’s behavior with a prescription for stronger medication, but also didn’t want to drive the patient away. “I trust the patient’s story about pain,” he said, “but I don’t want to be naïve.”Another student asked: “By increasing his dose, are you protecting him from getting the drugs off the street?”Dr. Wlasiuk said that although medical training typically urges students to come up with absolute answers, treating these patients often means getting comfortable with ambiguity.The students brainstormed with her and Dr. Buchheit. Some offered to raise the Percocet dose if he agreed to frequent office visits; others urged him to try physical therapy and acupuncture.A few remembered to caution Mr. McQ about opioids. (“Percocet is an opioid?” Mr. McQ responded. “I’m not one of those people!”)In an evenhanded tone, Chioma Anyikwa, 25, marched through Mr. McQ’s history and pain, which he had previously listed as four of 10.“A seven-plus,” he said.“Wow, that’s pretty high,” she said. “Did you do anything else to treat it?” Hesitantly, he spoke about sharing his girlfriend’s Dilaudid.“In your urine screen we also saw some cocaine,” she continued. “Do you know anything about that? I appreciate you being honest with me.”Mr. McQ looked uneasy. “It’s not gonna mess me up if I tell you?”She shook her head. “No, we just want to help you regroup and fix the problem,” she said.

Dr. Wlasiuk with Ms. Anyikwa and a patient, Brooke Anglin, during a checkup. “I am amazed by your strength,” Dr. Wlasiuk said.CreditKayana Szymczak for The New York TimesHe admitted that a friend had been in town and they did a few lines for old times’ sake.Afterward, Ms. Anyikwa braced for the group’s feedback.“Did I talk too much?” she asked.From classroom to clinicTwo days later, Ms. Anyikwa screened actual patients.Supervised by Dr. Wlasiuk, she spent a day at South Boston Community Health Center.

The first patient, Brooke Anglin, 28, had had a rough ride. During a turbulent relationship when she was sagged down by depression and severe anxiety, she soothed herself with opioids. After the birth of her second child, she lost both her job as a supermarket cake decorator and custody of her two children. Under Dr. Wlasiuk’s care, she gradually weaned herself off the opioids.As Dr. Wlasiuk looked on, Ms. Anyikwa began careful questioning. “How have things been going?” she asked the patient.Not great, Ms. Anglin replied. Earlier that week she had been evicted.“That’s a lot,” Ms. Anyikwa responded. “How are you coping?”Ms. Anglin said she’d had a resurgence of anxiety.That was enough for Dr. Wlasiuk to step in. “Is your heart racing? Are you feeling panicky?”Ms. Anyikwa watched Dr. Wlasiuk closely.“Have you felt you wanted something for it from your friends?” Dr. Wlasiuk gently pressed. “What’s stopped you?” Ms. Anglin whispered, “I want my kids back.”Dr. Wlasiuk grasped Ms. Anglin’s hands. “I am amazed by your strength,” she said. “I want to treat your anxiety until things settle down. What are your thoughts?”They agreed on temporary anti-anxiety medication. Dr. Wlasiuk also taught her breathing exercises.After the patient left, Dr. Wlasiuk remarked, “Primary care is the right place for treating substance misuse. We have the privilege of getting to know our patients well. How can you treat addiction in a vacuum?”The next up was Sharon, 61, who brought along a toddler grandchild. Both Sharon and her daughter, the child’s mother, take Suboxone, a medication that can ease opioid craving.Dr. Wlasiuk entered and Ms. Anyikwa started her recitation.“Sharon has been clean for years,” Ms. Anyikwa began.Vigilant about language and stigma, Dr. Wlasiuk interrupted her. “Clean” is eschewed by many in the field, because it implies that those in the throes of addiction are, by extension, “dirty.”

August 31, 2018 — More than 3,000 kits ready to be distributed citywide- New York City Fire Department

Fire Commissioner Daniel A. Nigro today announced the launch of the “Leave Behind” Naloxone Program, a strategy included in the expansion of HealingNYC, the citywide plan to combat the opioid epidemic. This new program increases naloxone distribution and training on how to use this lifesaving medication. Yearly, FDNY members treat approximately 5,000 suspected opioid overdose patients.Starting today, FDNY EMS personnel are trained and equipped to leave a personal naloxone kit with patients revived with naloxone. This kit will be offered to a patient during transport to the hospital, or at a scene of the overdose for patients who refuse further medical attention (RMA). Naloxone kits will also be available to friends and family members, if requested.“This Leave Behind Naloxone program provides patients and family members with an opportunity to access a naloxone kit during a suspected overdose, potentially preventing an opioid related death,” said Fire Commissioner Daniel A. Nigro. “Providing life-saving treatment, as well as education and instructions to prevent loss of life, is critical to the Department’s sworn mission of providing emergency pre-hospital care.”“We know that surviving a non-fatal overdose is one of the top risk factors for dying of overdose,” said Health Commissioner Dr. Mary T. Bassett. “By leaving behind naloxone with the friends and family of someone who survived an opioid overdose, EMS providers will provide a critical intervention and deliver naloxone to the people who need it most. I thank Commissioner Nigro and his team for adopting this program to save the lives of even more New Yorkers.”Each naloxone kit is stored within a blue pouch and contains naloxone intra-nasal spray, 4mg/0.1ml (2 doses), rubber gloves, face shield, alcohol wipes, literature about the risk of opioid overdose, recognition and rescue steps, naloxone use instructions, rehabilitation resources, and a blue prescription card.TO CONTINUE READING: https://www1.nyc.gov/site/fdny/news/fa7218/fire-commissioner-nigro-leave-behind-naloxone-program/#/0

Filthy hands gripping bloody needles, pregnant women shooting up, angelic toddlers in car seats with their parents slumped upfront, overdosed — media images of the opioid crisis are relentlessly dire.Fortunately, this is not the whole story. Around two million Americans are addicted to opioids. Yet many more have overcome their opioid problems. A large national population study found that almost all of those who once met criteria for prescription opioid-use disorder achieved remission during their lifetimes — and half of those recovered within five years. Although heroin and street fentanyl are more dangerous, most of those who avoid fatal overdoses recover from addiction.To improve the odds, we need to recognize and champion recovery — and the wide variety of forms it can take. In media and pop culture, when recovering people are seen at all, one type usually appears: someone who goes to rehab and then abstains from all drugs by relying on 12-step programs like Narcotics Anonymous.In fact, other recovery journeys are more common. For example, nearly half of those with prescription opioid addiction are able to recover without formal treatment or self-help participation.Moreover, many of those who recover do it through professional treatment with medications like methadone or buprenorphine, not through abstinence. Studies, including one of all patients in Britain treated for opioid addiction between 2005 and 2009, show that these two medications are the only treatments that reduce mortality by half or more when used long-term — and they cut relapse rates more than an abstinence approach.Other people take their own routes entirely. We find new passions in relationships, parenting, culture, exercise, work, art, spirituality, activism and community service. Some recover primarily by learning better ways to manage the trauma and mental illness that underlie many addictions. Some even kick opioids by using marijuana or psychedelic drugs.